High CAC score associates strongly with CVD/CHD mortality

USA: The presence of high coronary artery calcium (CAC) is strongly associated with a higher risk of cardiovascular disease (CVD) or coronary heart disease (CHD) related deaths and long-term all-cause mortality, suggests a recent study published in the JACC: Cardiovascular Imaging journal.

Although CAC is a known predictor of short-term, all-cause mortality, there is inadequate data on long-term and cause-specific mortality. Gowtham R. Grandhi, Yale-New Haven Hospital, New Haven, Connecticut, and colleagues sought to evaluate the association and burden of coronary artery calcium with long-term, cause-specific mortality across the spectrum of baseline risk.

The CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD. They were followed for a median of 12.5-years.

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Key findings of the study include:

• 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths.


• Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44 and HR: 4.15 respectively) compared with CAC of 0.


• Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09 and HR: 1.84) compared with those without RFs.


• Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0.